Introduction We evaluated the potential benefits of adding mag-
nesium sulphate (MgSO4) to ketamine (K) in a patient controlled
analgesia (PCA) model with tramadol (T) on postoperative pain
and cognitive function in major abdominal surgery.
Methods Twenty-four abdominal open surgery patients were
included in a double-blind, randomized study. After extubation a
PCA pump with T was placed to promote optimal analgesia. In the
first group K was added (0.5 mg/ml) to the pump (Gk, n = 6), in
the second group it was MgSO4 (0.03 mg/ml) (Gm, n = 6), in the
third group MgSO4 was adjunct to K (Gm-k, n = 6) and in the last
group NaCI 0.9% was added and served as the control group (Gc,
n = 6). Consumption of T and the cognition (using the Mini-Mental
State of Examination (MMSE) [1]) were evaluated at the end of
hospitalisation in the ICU. For statistical analysis, a Shapiro-Wilk
test, Wilcox text and Student t test were used.
Results K and MgSO4, separately added to T, did not improve
significantly its global consumption, demonstrating comparable
postoperative pain scales between groups (P = 0.08). MgSO4
coupled with K (Gm-k) improved postoperative pain compared with
Gc (P <0.05). This combination reduced the mean global T
consumption by 15% (50/0 SD) during the first 24 hours and by
25% (80/0 SD) during the second day of pump infusion compared
with the other groups (P <0.02). K and MgSO4 did not modify
cognitive functioning compared with the control group (mean
MMSE scoring: >28 2, SD) (P= 0.1).
Conclusions Adding a low dose of K or MgSO4 to T in post-
operative major abdominal surgery did not improve analgesia but
the combination of both had a statistical sparing effect on T
consumption. Magnesium plays a determinant role, by interacting
in the glutaminergic pathways, on the K effect. Cognitive deter-
minants in ICU patients are not modified by a low dose of K.
Reference
1. Folstein MF, Folstein SE, McHugh PR: 'Mini-Mental State', a
practical method for grading the cognitive state of
patients for the clinician. J Psychiatr Res 1975, 12:189-198.

Introduction Little is known about the potential hemodynamic
benefits of continuous ketamine sedation and analgesia in adult
ICU patients.
Methods In a pilot multicenter, prospective, double-blind,
randomized control trial, we screened 66 adult ICU patients who
required sedation and analgesia. Patients meeting entry criteria
were randomized to continuous infusion of ketamine (study) or
fentanyl (control) for >24 hours to achieve a Ramsay Sedation
Scale of 4. We recorded lung compliance and airway resistance.
Sixty percent of patients (3/5) received ketamine with low-dose
S164 midazolam for 24 hours followed by midazolam only and 40% (2/5)

received fentanyl. We measured dynamic compliance and airway
resistance for both groups before sedative infusion and every
4 hours thereafter.
Results There was a statistically significant increase in the
dynamic compliance in the study group compared with the control
group (P <0.05). There was a statistically significant decrease in
the airway resistance in the study group compared with the control
group (Figure 1).
Conclusions This preliminary report illustrates the possible value
of ketamine for continuous ICU sedation and analgesia.

Introduction Critically ill patients often require emergency
intubation with administration of etomidate as the sedative agent.
The use of etomidate has been challenged as it causes a reversible
adrenal insufficiency probably leading to an increase in hospital
morbidity.
Methods In this prospective, randomized, controlled, single-blind
trial, we assigned 234 patients to receive 0.3 mg/kg etomidate and
235 patients to receive 2 mg/kg ketamine for intubation. The
primary endpoint was the maximum value of the Sequential Organ
Failure Assessment score (SOFAmax) during the first inhospital
3 days. (ClinicalTrials.gov number, NCT00440102.)
Results The mean SOFAmax score between the two groups was
not significantly different (10.3 3.7 for etomidate vs. 9.6 3.9 for
ketamine; P = 0.056). There was no significant difference in 28-
day mortality (81 (35%) deaths vs. 72 (310/0) deaths, P = 0.36),
the number of patients needing catecholamine (137 (59%) patients
vs. 120 (51%) patients, P = 0.10), median (IQR) ventilator-free
days (12 (0 to 25) days vs. 15 (0 to 26) days, P = 0.36) and
median (IQR) hospital-free days (4 (0 to 22) days vs. 6 (0 to 23)
days, P = 0.57). Adrenal insufficiency incidence was significantly
higher in etomidate than ketamine group (86% vs. 48%, P<0.001).
There was no significant difference between the two groups in
intubation conditions. There was no significant difference in
outcome between the etomidate and ketamine groups on
prespecified subgroup analysis (trauma or sepsis patients).